Please print and fax back to (203) 323-3724

WAIVER OF ADVANCE ESTIMATE

I request that repairs be performed on my vehicle without an advance estimate

of their cost. By signing this form I authorize the reasonable and necessary costs

 to remedy the problems complained of up to a maximum of $_____________.00

DOLLARS.  The repair shop my not exceed this amount without my written

or oral consent.

Name:___________________________     Date:______________________

Year:_______   Make:_________________  Model:___________________

Signed:________________________________________________

AUTHORIZATION OF ADDITIONAL REPAIRS

ASSIGNMENT OF PROCEEDS AND DIRECTION TO PAY

If additional repairs beyond the waiver estimate are discovered and related to

the problems complained of, I request Barcello’s Auto Body to negotiate with _______________________________ insurance company in my behalf for

any additional monies due.  I also authorize and direct the insurance company

to pay directly to Barcello’s Auto Body all payments and supplements due on

the above claim. (PROPERTY DAMAGE ONLY)  It is understood that if these

payments are still sent to me I will forward it to Barcello’s Auto Body as they are

received.  I also insist that Barcello’s Auto Body use only original equipment

parts in the repair of my automobile.